Which roommate would be most suitable for the 6-year-old male with a fractured femur in Russell’s traction?
o A. 16-year-old female with
... [Show More] scoliosis
o B. 12-year-old male with a fractured femur
o C. 10-year-old male with sarcoma
o D. 6-year-old male with osteomyelitis
Incorrect
Correct Answer: B. 12-year-old male with a fractured femur
The 6-year-old should have a roommate as close to the same age as possible, so the 12-year-old is the best match. A bed is available and the patient gets assigned. There are certain constraints—sex, semi-private versus private, isolation issues, acuity, telemetry and specialty needs. All need to be taken into account to ensure that each patient goes to the right place and receives the proper care. But good capacity management demands that bed assignment be carefully considered and executed.
• Option A: The client is too old and is female. Bed assignment simply provides the proper location based on specific patient attributes like sex, isolation, telemetry, acuity, and specialty needs.
• Option C: The 10-year-old with sarcoma has cancer and will be treated with chemotherapy that makes him immune suppressed. Bed managers aim at finding an assignment of patients to rooms that strikes a balance between patients’ preferences and comfort on the one hand, and patients’ clinical conditions and the resulting required room facilities on the other.
• Option D: The 6-year-old with osteomyelitis is infectious. Rooms and beds belong to the critical assets of just any hospital. They account for a considerable part of a hospital’s infrastructure, and a large amount of financial resources are invested in equipping them with medical apparatus to facilitate patient care. Furthermore, they also represent the place where most patients will spend a large part of their stay, as they recover from surgery, wait for examinations to take place, etc.
2. 2. Question
A client with osteoarthritis has a prescription for celebrex (Celecoxib). Which instruction should be included in the discharge teaching?
• A. Take the medication with milk.
• B. Report chest pain.
• C. Remain upright after taking for 30 minutes.
• D. Allow 6 weeks for optimal effects.
Incorrect
Correct Answer: B. Report chest pain.
Cox II inhibitors have been associated with heart attacks and strokes. Any changes in cardiac status or signs of a stroke should be reported immediately, along with any changes in bowel or bladder habits because bleeding has been linked to use of Cox II inhibitors. Like all NSAIDs, celecoxib carries an FDA boxed warning for cardiovascular risk, including the increased risk of heart attacks and strokes. As a selective COX-2 inhibitor, celecoxib also faces scrutiny for increased cardiovascular risk, since another selective COX-2 inhibitor, rofecoxib, was withdrawn from production in 2004 due to cardiovascular risk concerns.
• Options A: The medication can be taken with water. Celecoxib is a medication that is taken orally and comes in 50, 100, 200, and 400 mg doses. In rare cases, celecoxib can also be added to customized compounds for topical administration with or without the use of iontophoresis or other topical delivery mechanisms. It is not available via any other route of administration.
• Option C: The client may remain upright but not necessarily for 30 minutes. Symptoms of celecoxib overdose would likely be similar to overdoses of other NSAIDs, which include lethargy, drowsiness, nausea, vomiting, and epigastric pain. Activated charcoal may be administered for overdose treatment at the discretion of emergency medical providers if the patient presents within 4 hours of known or suspected ingestion of significant amounts of celecoxib.
• Option D: Allow 6 weeks for optimal effect. In the inpatient setting, as mentioned above, celecoxib is increasingly being used as part of pre-operative and post-operative multimodal pain management algorithms. Research has shown in several small randomized trials that administering celecoxib peri-operatively for elective procedures such as total hip arthroplasties, total knee arthroplasties, and other procedures with some success in reducing pain and improving functionality such as early ambulation.
3. 3. Question
A client with a fractured tibia has a plaster-of-Paris cast applied to immobilize the fracture. Which action by the nurse indicates an understanding of a plaster-of-Paris cast? The nurse:
• A. Handles the cast with the fingertips
• B. Petals the cast
• C. Dries the cast with a hair dryer
• D. Allows 24 hours before bearing weight
Incorrect
Correct Answer: D. Allows 24 hours before bearing weight
A plaster-of-Paris cast takes 24 hours to dry, and the client should not bear weight for 24 hours. After the process of applying the casting material is completed, the material will start to dry in about 10 to 15 minutes. The temperature of the skin might rise as the plaster is drying because of a chemical reaction that occurs. When plaster is used, it can take from 1 to 2 days for the cast to harden completely.
• Option A: The cast should be handled with the palms, not the fingertips. Use the palm of hand to apply, hold, or move cast and support on pillows after application. Uneven plaster is irritating to the skin and may result in abrasions.
• Option B: Petaling a cast is covering the end of the cast with cast batting or a sock, to prevent skin irritation and flaking of the skin under the cast. Trim excess plaster from edges of the cast as soon as casting is completed; prevents skin breakdown caused by prolonged moisture trapped under the cast.
• Option C: The client should be told not to dry the cast with a hair dryer because this causes hot spots and could burn the client. This also causes unequal drying. Promote cast drying by removing bed linen, exposing it to circulating air; pressure can cause ulcerations, necrosis, or nerve palsies. Pad (petal) the edges of the cast with waterproof tape; provides an effective barrier to cast flaking and moisture. Helps prevent the breakdown of cast material at the edges and reduce skin irritation and excoriation.
4. 4. Question
The teenager with a fiberglass cast asks the nurse if it will be okay to allow his friends to autograph his cast. Which response would be best?
• A. "It will be alright for your friends to autograph the cast."
• B. "Because the cast is made of plaster, autographing can weaken the cast."
• C. "If they don’t use chalk to autograph, it is okay."
• D. "Autographing or writing on the cast in any form will harm the cast."
Incorrect
Correct Answer: A. “It will be alright for your friends to autograph the cast.”
There is no reason that the client’s friends should not be allowed to autograph the cast; it will not harm the cast in any way, so answers B, C, and D are incorrect. Fiberglass has several advantages compared to plaster. It weighs less, so the cast made from it will be lighter. More durable and porous, fiberglass allows air to flow in and out. Fiberglass is the better choice in case the limb must be X-rayed during the healing process. It is also available in a variety of colors.
• Option B: Plaster costs less than fiberglass and is more malleable (is more easily shaped) than fiberglass in certain cases. Plaster comes in strips or rolls that are moistened and rolled on over the padding. Plaster materials are made from dry muslin that is treated with starch or dextrose and calcium sulfate.
• Option C: Keep the cast clean and dry. A hair dryer with a cool setting may be used to dry a fiberglass cast if it becomes damp. Call a doctor if the cast does not dry or if the skin under the cast becomes wet. Avoid placing pressure or weight on the cast. If you have a leg injury and have a walking cast, make sure that the cast has hardened completely before you attempt to walk on it.
• Option D: Like plaster, fiberglass materials come in rolls. Strips are moistened and applied to form the cast. The cast will appear rough after it has dried. Do not place any objects inside the cast. Avoid using lotions or powders on skin underneath the cast.
5. 5. Question
The nurse is assigned to care for the client with a Steinmann pin. During pin care, she notes that the LPN uses sterile gloves and Q-tips to clean the pin. Which action should the nurse take at this time?
• A. Assisting the LPN with opening sterile packages and peroxide.
• B. Telling the LPN that clean gloves are allowed.
• C. Telling the LPN that the registered nurse should perform pin care.
• D. Asking the LPN to clean the weights and pulleys with peroxide.
Incorrect
Correct Answer: A. Assisting the LPN with opening sterile packages and peroxide
The nurse is performing the pin care correctly when she uses sterile gloves and Q-tips. All pins and wire sites must be cleaned daily. Basic pin care will be performed once daily by the hospital nursing staff prior to discharge from the hospital. Following discharge, the patient and family will go to the clinic for pin care teaching and instructions.
• Option B: During pin care, the sterile technique is utilized and sterile gloves are needed. The approach to pin care should occur in a stepwise fashion. If step one is effective there is no need to go further and pins can be wrapped with gauze. If step one is not effective, please continue until effective pin care has been achieved.
• Option C: A licensed practical nurse can perform pin care. Pin care is recommended during showers, after pool therapy, or swimming in the pool or ocean (ocean saltwater is good for pin sites). Ideally, pin sites are cleaned when the surrounding skin and gauze are soft. This should make removal of gauze and cleaning of pins less painful.
• Option D: There is no need to clean the weights. The purpose of the cleaning is to prevent the skin from attaching to the pins and wires and to clean and inspect the area to decrease the chance of infection.
6. 6. Question
A child with scoliosis has a spica cast applied. Which action specific to the spica cast should be taken? [Show Less]